Active NPI
Breanne Dietz, PHARM. D
- Pharmacist
- Maplewood, MN
National Provider Identifier
1306432356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 123776
- Practice address
- 100 County Road B W
Maplewood, MN 55117-1931 - Phone
- (651) 489-6271
- NPI assigned
- Dec 14, 2020
- Last updated
- Dec 14, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 123776 | MN | Primary |
Addresses
Primary practice location
100 County Road B W
Maplewood, MN 55117-1931
Mailing address
100 County Road B W
Maplewood, MN 55117-1931
Phone (651) 489-6271
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 123776 | MN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Supervalu Pharmacies Inc. | Past | Accepting new patients | |
| Supervalu Pharmacies Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607904000000",
"number": "1306432356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 COUNTY ROAD B W",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551171931",
"telephone_number": "651-489-6271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 COUNTY ROAD B W",
"city": "MAPLEWOOD",
"state": "MN",
"postal_code": "551171931",
"telephone_number": "651-489-6271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZ",
"first_name": "BREANNE",
"credential": "PHARM. D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-14",
"last_updated": "2020-12-14",
"certification_date": "2020-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MN",
"license": "123776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maplewood, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.